45D1049267 CLIA NUMBER - DESTINATION HEALTH

Laboratory Demographics

  • CLIA Code: 45D1049267
  • Facility Name: DESTINATION HEALTH
  • Facility Address: 900 E SOUTHLAKE BLVD SUITE 200
    SOUTHLAKE, TX
    ZIP 76092
  • Facility Phone: 817 310-6050
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CARL DUCHARME
  • NPI Number: 1346646528
  • Taxonomy: 207QA0505X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D1049267
LAB Type Physician Office
Facility Name DESTINATION HEALTH
Street 900 E SOUTHLAKE BLVD SUITE 200
City SOUTHLAKE
State TX
ZIP 76092
Phone 817 310-6050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/30/2023
Certificate Expiration Date 12/29/2025
Facility Type Physician Office
Lab Director CARL DUCHARME

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This page was last updated on: 9/29/2025